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<title>.::Student Registeration Form::.</title>
</head>

<body background="images/background.gif" topmargin="0" style="text-align: center">


<table border="0" style="border-collapse: collapse" width="100%" id="table2">
  <!--DWLayoutTable-->
	<tr>
		<td height="93" bgcolor="#349B02">
	    <p align="center">
	      <object classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=7,0,19,0" width="709" height="142">
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      </td>
	    <td width="16"></td>
	</tr>
	<tr>
		<td height="19" valign="top" bgcolor="#B7BCC6" style="border-left-width: 1px; border-right-width: 1px; border-top-style: solid; border-top-width: 1px; border-bottom-width: 1px">
		<p align="right"><b><font face="Arial" size="1">Logout&nbsp;&nbsp;&nbsp; Change 
		Password</font></b></td>
	    <td></td>
	</tr>
</table>
<div align="center">
	<table id="table3" style="BORDER-COLLAPSE: collapse" width="92%" border="0">
		<tr>
			<td vAlign="top" align="right" height="0">
			<p align="left"><font face="Arial" size="2"><a href="registeration.jsp">Tambah Data Mhs</a> <a href="Delete.jsp">Hapus</a>&nbsp;Edit || Tambah</font></td>
		</tr>
	</table>
</div>
<form method="POST" action="Reg.jsp" name="Registeration">

	<table border="0" style="border-collapse: collapse" width="100%" id="table1">
		<tr>
			<td align="center" height="32" colspan="3" style="border-left-width: 1px; border-right-width: 1px; border-top-style: solid; border-top-width: 1px; border-bottom-style: solid; border-bottom-width: 1px" bgcolor="#808080">
			<b><font size="5" face="Arial" color="#FFFFFF">Data Mahasiswa</font></b></td>
		</tr>
		<tr>
			<td align="center" height="21" colspan="3" style="border-left-width: 1px; border-right-width: 1px">&nbsp;</td>
		</tr>
		<tr>
			<td width="214" align="center" height="22">&nbsp;</td>
			<td width="182" align="left" height="22">NIM</td>
			<td height="22" align="left"><font face="Arial Narrow"><input type="text" name="T1" size="23">
			</font></td>
		</tr>
		<tr>
			<td width="214" align="center" height="23">&nbsp;</td>
			<td width="182" align="left" height="23"><font face="Arial">Nama</font></td>
			<td height="23" align="left"><font face="Arial Narrow"><input type="text" name="T2" size="23">
			</font></td>
		</tr>
		<tr>
			<td width="214" align="center" height="23">&nbsp;</td>
			<td width="182" align="left" height="23"><font face="Arial">Password</font></td>
		  <td height="23" align="left">
			<font face="Arial Narrow">
			<input name="T3" size="23" type="password"></font></td>
		</tr>
		<tr>
			<td width="214" align="center">&nbsp;</td>
			<td width="182" align="left"><font face="Arial">Nama Ayah </font></td>
			<td align="left"><font face="Arial Narrow"><input type="text" name="T4" size="23"></font></td>
		</tr>
		<tr>
			<td width="214" align="center">&nbsp;</td>
			<td width="182" align="left"><font face="Arial">Tempat/Tgl Lahir </font></td>
			<td align="left"><font face="Arial Narrow"><input type="text" name="T5" size="23">
			</font></td>
		</tr>
		<tr>
			<td width="214" align="center" height="22">&nbsp;</td>
			<td width="182" align="left" height="22"><font face="Arial">Kewarganegaraan
			</font></td>
			<td height="22" align="left"><font face="Arial Narrow"><input type="text" name="T6" size="23">
			</font></td>
		</tr>
		<tr>
			<td width="214" align="center">&nbsp;</td>
			<td width="182" align="left"><font face="Arial">Alamat</font></td>
			<td align="left"><font face="Arial Narrow">
        <textarea name="T7" cols="35" rows="4"></textarea>
        </font></td>
		</tr>
		<tr>
			<td width="214" align="center">&nbsp;</td>
			<td width="182" align="left"><font face="Arial">Kota</font></td>
			<td align="left"><font face="Arial Narrow"><select size="1" name="T8">
			<option selected>Pekanbaru</option>
			<option>Duri</option>
			<option>Dumai</option>
			<option>Bangkinang</option>
			<option>Bengkalis</option>
			<option>Kuala Lumpur</option>
			<option>Singapura</option>
			<option>Dili</option>
			<option>Thailand Selatan</option>
			</select></font><font size="2" face="Arial Narrow">&nbsp; </font></td>
		</tr>
		<tr>
			<td width="214" align="center">&nbsp;</td>
			<td width="182" align="left"><font face="Arial">Negara</font></td>
			<td align="left"><font face="Arial Narrow"><select size="1" name="T9">
			<option selected>Indonesia</option>
			<option>Malaysia</option>
			<option>Thailand</option>
			<option>Brunei Darusslam</option>
			<option>Timor Leste</option>
			<option>Singapura</option>
			</select></font></td>
		</tr>
		<tr>
			<td width="214" align="center" height="23">&nbsp;</td>
			<td width="182" align="left" height="23"><font face="Arial">Telepon</font></td>
			<td height="23" align="left">
			<font face="Arial Narrow">
			<input type="text" name="T10" size="23"></font></td>
		</tr>
		<tr>
			<td width="214" align="center">&nbsp;</td>
			<td width="182" align="left"><font face="Arial">HP</font></td>
			<td align="left"><font face="Arial Narrow"><input type="text" name="T11" size="23"></font></td>
		</tr>
		<tr>
			<td width="214" align="center">&nbsp;</td>
			<td width="182" align="left"><font face="Arial">Nomor Identitas </font></td>
			<td align="left"><font face="Arial Narrow"><input type="text" name="T12" size="23">
			</font></td>
		</tr>
		<tr>
			<td width="214" align="center">&nbsp;</td>
			<td width="182" align="left"><font face="Arial">Email</font></td>
		  <td align="left"><font face="Arial Narrow"><input type="text" name="T13" size="23">
			</font></td>
		</tr>
  </table>
	<p align="center"><input type="submit" value="Submit" name="B1"><input type="reset" value="Reset" name="B2"></p>
</form>

</body>

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